Understanding Arthritis Brought to you in collaboration with: Arthritis Foundation Tennessee Chapter Tennessee Department of Health University of Tennessee Extension rev. June 2009

Arthritis Defined Arthritis: “inflammation of a joint” Rheumatism: Better term, broad, encompasses all kinds of pain and stiffness in the muscles and joints Most common feature is PAIN Over 120 different types of arthritis NO CURE: Chronic. Why self-management is so important.

The Impact of Arthritis The leading cause of disability among American adults One of the most common chronic health problems in the United States Affects people of all ages Affects over 46 million Americans (1 of every 5 adults)

Impact of Arthritis (continued) Twice as many women as men have the disease More frequent cause of activity limitations than heart disease, cancer or diabetes Limits activities of over 7 million Americans Causes 39 million doctor visits, and over half-a-million hospitalizations each year Costs the U.S. economy $128 billion a year $81 billion in medical costs

Burden of Arthritis in Tennessee 1.5 million adults have arthritis 72% of people with arthritis are less than 65 years of age Almost 26.6% of adults have been diagnosed with some form of arthritis

Burden of Arthritis in Tennessee Of those diagnosed: 43% don’t know the type of arthritis they have 55% are not under a physician’s care Source: 2005 Behavioral Risk Factor Surveillance Survey data (Centers for Disease Control and Prevention Survey)

Burden of Arthritis in Tennessee More common in Whites (36%) than Blacks (33%) More common in Women (41%) than Men (30%) People with arthritis are more likely to be obese (30%) People with arthritis more likely report days of poor physical health and/or mental health when compared to others

Symptoms of Arthritis Swelling in one or more joints Morning stiffness lasting ≥ 30 minutes Persistent joint pain or tenderness Inability to move a joint in a normal way Redness or warmth in a joint Weight loss, fever or weakness Joint pain that can not be explained

Healthy Joint Anatomy Muscles Joint capsule Tendons Synovial membrane Bone Synovial fluid Cartilage In a healthy joint, the ends of bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a synovial membrane that produces synovial fluid. The capsule and fluid protect the cartilage, muscles, and connective tissues.

A Joint with Osteoarthritis Muscles Bone spurs Tendons Synovial membrane Bone Synovial fluid Cartilage fragments in fluid Worn away cartilage With osteoarthritis, the cartilage becomes worn away. Spurs grow out from the edge of the bone, and synovial fluid increases. Altogether, the joint feels stiff and sore.

Joints Most Often Affected Osteoarthritis most often occurs at the ends of the fingers, thumbs, neck, lower back, knees, and hips. Osteoarthritis most often occurs at the ends of the fingers, thumbs, neck, lower back, knees, and hips.

Types of Arthritis Osteoarthritis (OA) Rheumatoid Arthritis (RA) Fibromyalgia Syndrome (FMS) Lupus – Systematic Lupus Erythematosus (SLE) Juvenile Rheumatoid Arthritis (JRA)

Osteoarthritis (OA): By Far The Most Common Form Also called degenerative joint disease Usually begins after age 45 Causes symptoms in 1 of every 3 individuals over age 60

Osteoarthritis (OA): By Far The Most Common Form Caused by breakdown of the joint’s cartilage Bones rub together Joint loses shape and alignment Bone ends thicken Bit of cartilage or bone float in joint space Pain, inflammation and stiffness result

Osteoarthritis Risk Factors Age Overweight Joint Injury Muscle weakness Heredity

Rheumatoid Arthritis (RA) Affects about 2.1 million Americans, and three time more women than men Caused when the immune system attacks the lining of the joints Can result in severe joint damage and deformity May also cause fatigue, weight loss and other whole-body symptoms Rheumatoid Arthritis is a chronic inflammatory disease of the joints. The disease occurs when the body’s immune system – which normally protects from us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, inflammation, loss of function and disability. The joints most commonly affected by rheumatoid arthritis are those of the hands, feet, wrists, knees, elbows, knees and ankles.

Fibromyalgia Syndrome (FMS) Joints not affected Muscles, ligaments and tendons affected Sleep disturbances Over half of people have chronic fatigue Fibromyalgia (or fibromyalgia syndrome) is an arthritis-related condition characterized widespread muscle pain and the presence of tender points, or areas of the body that are particularly sensitive to pressure. Other symptoms may include sleep disturbances, severe fatigue, depression and anxiety, cognitive difficulties, headaches, bladder irritability and spasms, irritable bowel syndrome, jaw problems and painful menstruation.

Fibromyalgia Syndrome (FMS) Cause is unknown 1990 first defined: Pain and stiffness in many parts of the body for at least 3 months and local tenderness in 11 of 18 specified places 3.7 million in the U.S. – no TN data Good prognosis Exercise and relaxation essential Fibromyalgia affects more than 3.7 million Americans, the majority of whom are women between the ages of 40 and 75, but it also affects men, young women and children as well. People with other rheumatic diseases, such as rheumatoid arthritis or lupus, are at greater risk for fibromyalgia.

Lupus Rheumatic disease that affects the skin and body tissues – autoimmune disease Possibly organs such as the kidneys, lungs or heart Affects women more than men Primarily a young woman’s disease Affects more African Americans than Caucasians Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Lupus is also a disease of flares (the symptoms worsen and you feel ill) and remissions (the symptoms improve and you feel better). Lupus can range from mild to life-threatening and should always be treated by a doctor.

Chronic Pain Cycle Arthritis may cause you pain because of inflammation or bone rubbing against bone “Disease”. In response to this pain, and to protect the area that hurts, your body unconsciously tends to tighten up in that area, or compensate by using other muscles “Tense Muscles”. When these muscles are tightened for a long period of time, they create even more pain. As your pain mounts, you become stressed and more tense, wondering if the pain will ever get better “Stress and Anxiety” . Your stress could keep you from performing your everyday activities which leads to “frustration/anger/fear/worry” then “depression” and “fatigue”. Your pain is now worse, completing the vicious cycle.

Arthritis Medications Medications are important to your management of pain. When taken properly, medications can reduce pain and increase joint mobility. Medications will not cure arthritis, but they can keep your symptoms under control and make life more comfortable. Medication is major catalyst in breaking the Pain Cycle. When used properly, medications can reduce pain which in turn reduces tension and stress. When stress and tension in the body is decreased, the chance of developing frustration, depression and fatigue is also lessened.

Importance of a Healthy Weight Maintaining a healthy weight is an important key to managing arthritic pain. The less stress (weight) you put on your joints, the less pain you will experience. Increased Muscle Mass=Increased Bone Density=Decreased Body Fat=Healthier Joints=Happier You!

Importance of Healthy Weight Keys to achieving a healthy weight Move more and eat less! Strive to eat a minimum of 5 servings of fruits and vegetables (2 cups vegetables and 1 ½ cups of fruit) each day. Reduce portion sizes (Healthy Plate Method). Aim to exercise (walk, bike, swim, garden) for 15-30 minutes each day. Fruit and vegetable serving recommendations are based upon a caloric intake of 1600 calories a day. Recommend that participants eat a minimum of 2 cups of vegetables and 1 ½ cups of fruit each day. Exercise also plays an important role in breaking down the Pain Cycle. Endurance exercises are an excellent treatment for tense muscles, stress and tension, for working our difficult emotions, stress, and fatigue. Exercise also improves sleep patterns.

Arthritis Management Programs Arthritis Self-Help Program Arthritis Foundation Exercise Program Arthritis Foundation Tai Chi Program

Arthritis Self-Help Program The Self-Help program is an in-depth program that gives newly and previously diagnosed individuals with arthritis the knowledge and skills needed to better manage their disease. Led by UT Extension Educators certified by the Arthritis Foundation. The Arthritis Foundation Self-Help Program is a group education program designed to complement the care provided by your health-care team and allow you to share experiences with others

Arthritis Self-Help Program The Arthritis Foundation Self-Help Program is designed to: Identify and teach you the latest pain management techniques Help you develop your own individualized exercise program Help you learn to manage fatigue and stress more effectively

Arthritis Self-Help Program The Arthritis Foundation Self-Help Program is designed to: Discuss the purposes and effective use of medications Help you learn new ways to communicate with family and friends Teach you how to form a partnership with your healthcare team.

Arthritis Self-Help Program Participants will learn how to: Reduce arthritic pain and stress Cope with fatigue Manage pain Use medications wisely Benefit from exercise

Arthritis Foundation Exercise Program The Arthritis Foundation Exercise Program is a 60-minute class held twice a week. It is designed to improve endurance and joint motion. The low-impact program offers 2 types of classes – Basic and Advanced.

Arthritis Foundation Exercise Program Program benefits include: Joint stiffness relief Decreased arthritic pain Decreased depression Increased energy Increased flexibility Better, more relaxed sleep Increased functional ability

Arthritis Foundation Tai Chi Program Led by Extension Educators certified by the Arthritis Foundation Tai Chi Instructor program The Arthritis Foundation Tai Chi Program is a 60-minute class held twice a week Appropriate for individuals with mild to moderate arthritis Arthritis Foundation Tai Chi Program® is designed to improve the quality of life for people with arthritis using Sun style Tai Chi, one of the four major recognized styles of Tai Chi. This style includes agile steps and exercises that may improve mobility, breathing and relaxation. The movements don't require deep bending or squatting, which makes it easier and more comfortable to learn. The program itself consists of 12 movements — 6 basic and 6 advanced — a warm up and a cool down. Once becoming familiar with the 12 movements, the program is designed to provide continual challenge by reversing the direction of the movements.

Arthritis Foundation Tai Chi Program Program benefits include: Decreased pain and stiffness in joints Improved daily physical functioning Improved balance leading to decrease in falling Improved abdominal muscle strength Increased confidence in one’s ability to exercise

Monitoring Your Progress Exercise

Rating of Perceived Pain Scale

Monitoring Your Progress Self-Help

Discussion Questions